What You Will Learn Today

2. What You Will Learn Today • How the ear works. • How to interpret the audiogram. • Treatment Options for Hearing Loss. • Steps to determine cochlear implant candidacy. • Management of a child with a cochlear implant.

3. How the Ear Works The ear consists of four main parts: Brian Inner Ear Outer Ear Auditory Nerve Middle Ear

4. How the Ear Works Outer and Middle Ear Bones of the Middle Ear Ear Drum

5. How the Ear Works Cochlea Brain Cochlea Auditory Nerve

6. What You Will Learn Today • How the ear works. • How to interpret the audiogram. • Treatment options for hearing loss. • Steps to determine cochlear implant candidacy. • Management of a child with a cochlear implant.

7. The Audiogram Audiogram: A graph that shows an individuals type and degree of hearing loss.

8. The Audiogram Frequency Low Pitch to High Pitch Loudness Soft to Loud

9. The Audiogram Normal Hearing Mild Loss Moderate Loss Moderate Severe Loss Severe Loss Profound Loss

10. The Audiogram x o x o x o x o x o x o

11. The Audiogram x o x o o o o x x x x o

12. The Audiogram Three Types of Hearing Loss Sensorineural Conductive Mixed

13. The Audiogram < x o < x o < < < x o x o x o x o

14. The Audiogram < < < < < x o x o x o x o x o x o

15. The Audiogram < < < < x o < x o x o x o x o x o

16. Hearing Loss Brain Without functioning hair cells sound information cannot reach the brain for processing. Damaged Hair Cells in Cochlea

17. What You Will Learn Today • How the ear works. • How to interpret the audiogram. • Treatment Options for Hearing Loss. • Hearing Aids • Cochlear Implants • Steps to determine cochlear implant candidacy. • Management of a child with a cochlear implant.

18. Treatment Options for Hearing Loss Cochlear Implants Hearing Aids

19. Treatment Options for Hearing Loss Hearing Aids Behind-the-ear In-the-Canal In-the-Ear

20. How is a Cochlear Implant Different From a Hearing Aid? • Hearing Aids—acoustically amplify speech. • Cochlear Implants—convert speech information into electrical signals. • Hearing Aids—rely on the responsiveness of healthy, inner ear sensory cells. • Cochlear Implants—bypass the inner ear sensory cells and stimulate the hearing nerve directly.

21. How Does a Cochlear Implant Work? A Cochlear Implant consists of two main parts: Internal Equipment External Equipment or

22. Internal Equipment HiRes™ 90K Internal Electronics Electrode Array 3 turn gold wire coil Removable Magnet

23. External Equipment For a Cochlear Implant Speech Processors Battery Supply Headpiece Microphone Cable

24. How Does a Cochlear Implant Work? • Sound waves enter through the microphone. • The sound processor converts the sound into a distinctive digital code. • The electrically coded signal is transmitted across the skin through the headpiece to the internal portion of the device. • The internal device delivers the sound to the electrodes. • The electrodes stimulate the hearing nerve. • The hearing nerve sends the signal to the brain for processing.

25. What You Will Learn Today • How the ear works. • How to interpret the audiogram. • Treatment Options for Hearing Loss. • Hearing Aids • Cochlear Implants • Steps to determine cochlear implant candidacy. • Management of a child with a cochlear implant.

26. Steps to Determine Pediatric Cochlear Implant Candidacy • Audiologic Evaluation. • Medical Evaluation. • Speech Language Evaluation. • Psychological Evaluation. • Educational Evaluation. • Evaluation of parent expectations.

27. Who is a Candidate for a Cochlear Implant? • Adults (18 years+) • 70dB thresholds Less than 50% speech recognition with hearing aids. Children (18 mos+) •  70dB thresholds • General plateau in auditory development. • Children (12mos-18mos) >90dB thresholds General plateau in auditory development.

28. Candidate Profile Age 2 Speech recognition with Hearing Aids: Able to detect the pattern differences in words. A A A A A x o x o x o x o o x o x

29. Candidate Profile A Age 6 Speech recognition with Hearing Aids: 40% A A A x o A x o x o o x o x o x

30. What You Will Learn Today • How the ear works. • The Audiogram • Hearing Loss • How a cochlear implant works • Steps to determine cochlear implant candidacy. • Management of a cochlear implant.

31. Management of a Child with a Cochlear Implant • Audiologic management. • Rehabilitation. • Parent commitment. • School Support.

32. Audiologic Management “Initial Stimulation” or “Hook Up”

33. Audiologic Management • T level—electrical current necessary to just detect the presence of sound. • M Level—electrical current necessary to hear the incoming sound as loud but comfortable. • Sound Coding Strategy—Methodology or “formula” used to transcribe acoustic sound into an electrical code.

34. Audiologic Management Mapping very young children: • Clinical Experience • Objective Measures

35. Audiologic Management Follow Up Mapping

36. Rehabilitation Rehabilitation is KEY A cochlear implant is NOT a “cure” for hearing loss.

37. Parent Commitment

38. School Support • Understand what a cochlear implant is and how it functions. • Understand the external equipment and how to complete troubleshooting. • Know where to find support and resource materials. • Openly communicate with the student’s cochlear implant center.

39. Advanced Bionics Bionic Ear Association (BEA) Do you want to learn more about cochlear implants? • The BEA provides support, information, education, and guidance for cochlear implant candidates, cochlear implant users, hearing health care professionals, and school personnel. • Join the BEA today. You can join by visiting www.bionicear.com. Click on support for details.

40. Bionic Buddy Questions and Discussion….